Provider Demographics
NPI:1679537435
Name:BUSTILLO, JORGE (MD)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:
Last Name:BUSTILLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 BERNVILLE ROAD
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19605-9453
Mailing Address - Country:US
Mailing Address - Phone:610-378-2000
Mailing Address - Fax:610-378-2799
Practice Address - Street 1:2494 BERNVILLE ROAD
Practice Address - Street 2:SUITE 205
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19605-9469
Practice Address - Country:US
Practice Address - Phone:610-378-2996
Practice Address - Fax:610-208-8812
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0078545207X00000X
PAMD421803207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA580344OtherMEDICARE
PA0019586400010Medicaid
MD745419800Medicaid